9 PARALLEL ST - BUILDING INSPECTION The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CNIR SdMar� Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or ish a
One-or Tivo-Family Dwelling
This Section For Official I nly
Building Per Number:,
Building Official(Print Name) Signature
SECTION 1: SITE INFORMATION
i l PrrVy Address- 1.2 Assessors Map& Parcel Numbers
ra
1.1 a Is this an accepted street?yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq tt) Frontage(ft)
1.5 Building Setbacks (ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private ❑ - Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2:; PROPERTY OWNERSHIP':
2. w}ptert 0f ecpprd: /(� //
h A ticrwq/ I�n/lnt AA0A / G /ewm PM G/370
Name int) City,State P let,✓•�\UfN .L
�a/c �Id S� 78- �y%SSJU /er,LGvl.y�e[
No. andStreet - Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORIC''(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 .Alteration(s) Cl I Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed}Vo kr: I On
f/'1 i.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only.,,
Labor and Materials y
I. Building $ 1. Building PermitFee S fndtcate how fee is determined:
�. Electrical S ❑ Standard City/PownApplication Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing ) 2. Other Fees: S
I, Mechanical ([IVAC) S List:
i. Mechanical (Fira $
Suppression)
Total:\Il Fees: S
Check No Clieck Amount: Cash \mount
l'ntal Pro
jcct Cost $ ❑ Paul in Full ❑ Outstanding 13 tlonco Duo:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License (CSL)
License Number G.epiratimt Date
Namc of CSL I loldcr
List CSC Type(see below)
No. and Street NI [
Description
ricted Building s u to 35.000 cu. ft.)
_ ted 1&2 FamilyDwelling
City/Town, State, `LIP r
Coverin
w and Sidin
uel Burning Appliances
tion
rele hone Email address I D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
I IIC Company Name or IIIC Registrant Name
No.and Street Email address
City/Town,State, ZIP Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. e. 152, § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... 0 No ...........❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject property, hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering m ame below, I hereby attest under the pains and penalties of perjury that all of the information
containe ``' this application is true and accurate to the best.of my knowledge and understanding.
tic,✓- (� P /3
o Date
riot OwnsS or Authorized:\gent's Name(Electronic Signature)
NOTES:
I. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor
(nut registered in the Home Improvement Contractor(HIC) Program), will not have access to the arbitration
program or guaranty fluid under M.G.L. c. I42A. Other important information on the HIC Program can be found at
t visor License can be found at www.ntass., ovrd r.;
htformation on the Construction St er
a P
•
2. When substantial work is planned, provide the information below:
Total Floor area(,c1. ft.) (including garage, finished basement/attics, decks or porch)
—
Gros living area(sy. tt.) _ Habitable room count
Miniber of tiro laces Number of bedrooms _-- --- --
Nuntber of haHibailvs
?Jumberutbathnwnts
I'vpe of heating System " _ - - -- --- Number ordecksl porches
1'�peurcoolingsy;iein liuclosed ---Open
� }- Total I'ngect Squ:u'a Puotae may be sub,hh;ted t;,r..5,t.;l I'ngs[('o,t